Arthritis Gout (2) Flashcards Preview

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Flashcards in Arthritis Gout (2) Deck (28)
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1
Q

5 drugs that can elevate serum urate and precipitate gout

A
thiazies
loop diuretics
niacin
calcineurin inhibitors
asprin
2
Q

What class of drugs is first line urate-lowering therapy in gout? 2 examples?

A

Xanthine Oxidase Inhibitors (XOI)

allopurinol or febuxostat

3
Q

allopurinol MOA and indications

A

reduces uric acid synthesis by inhibiting xo(converts purines to uric acid)

for hyperuricemia of gout or recurrent kidney stones

4
Q

allopurinol considerations

A

starting dose no greater than 100mg/day
gradually titrate up

starting dose must be less than 100 in pts with kidney disease

5
Q

Pts started on allopurinol should be warned…

A

an acute gout flare could occur upon starting therapy

HA and somnolence can occur as well as jaundice

6
Q

Hypersensitivity to allopurinol can occur in those of ______ descent with HLA______

A

asian descent

HLA-B*5801

7
Q

Febuxostat MOA and indications

A

selectively inhibits XO

for hyperuricemia

8
Q

Febuxostat monitoring

A

LFT(liver), serum uric acid, and s/s of stroke, MI or hypersensitivity

9
Q

Febuxostat is recommended to be taken with ______ or ______ to prevent acute flares

A

NSAID or Colchicine

10
Q

If XOI drugs contraindicated what 3 drugs are the alternative

A

probencid
fenofibrate
losartan

11
Q

Probencid is not recommended as a monotherapy in

A

gout pts with low creatinine clearance (~50ml/min)

12
Q

Hx of ______ contraindicates probencid monotherapy

A

urolithiasis (stone forming)

13
Q

Probencid MOA

A

inhibits reabsorption of urate in prox convoluted tubule (which inc excretion of uric acid)

DONT START UNTIL ACUTE ATTACK HAS SUBSIDED
(may want alkalize urine and drink plenty of H2O to avoid stones)

14
Q

7 ADR of probencid

A

HA dizzy anemia flushing sore gums, nausea, stones

15
Q

Probencid levels are inc by _____

A

asprin and other salicylates

16
Q

______ and ______ are appropriate 1st line prophylaxis therapy

A

colchicine (1st line) and NSAIDs

17
Q

Pegloticase

A

approp for pts with severe gout and intolerance to oral ULT

18
Q

Pegloticase MOA

A

recomb urate-oxidase enzyme which converts uric acid to allantoin

discontinue other oral antihyperuricemic agent 1st

premedicate with antihist and corticosteroids

19
Q

Pegloticase monitoring and ADRs

A

serum uric acid levels s/b less than 6mg

antibody formation
acute gout flare

20
Q

3 therapies that you should treat acute gout with 1st

A

NSAIDs (or COX-2 inhibitor)
systemic corticosteroids
colchicine

21
Q

_________ are contraindicated in acute gout

A

Asprin and other salicyclates (bc inhibit uric acid excretion)

22
Q

Colchicine MOA and ADRs

A

moa: prevents leukocyte chemotaxis and phagocytosis
(NO effect on uric acid levels or analgesic effect

adr: N/v/d bone marrow dep with chronic use

23
Q

with gout you may consider _________ if large joints are involved

A

intraart injection of corticosteroids

24
Q

__________, ________, and ________ are all FDA approved NSAIDs for acute gout

A

indomethacin
naproxen
sulindac

25
Q

________ is the cox 2 inhib approved for acute gout

A

celecoxib

26
Q

Indomethacin adr

A

may aggravate depression or other cns disterbances such as epilepsy and parkinsonism

27
Q

______ and _______ are oral steroids you might give for gout.

A

predinsone and methylprednisone

28
Q

________ is an IM steroid for gout

A

triamcinolone